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Screening for a better future in your later years

While frailty is linked with getting older, the two don’t have to go hand in hand. It’s about taking early interventions to help stay healthy and active for longer.

Prevention and management however, can only start when you realise that you – or someone you love – is becoming frail or at risk of frailty. Fortunately, easy and fast tools that assess your risk of frailty have been developed and validated by researchers.

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Knowing your frailty risk

As you are no doubt aware, Australia’s population is ageing, with the Australian Bureau of Statistics predicting a more rapid increase in the proportion of people aged 65 or over in the next decade. Furthermore, research indicates one in five Australians in this group are frail, while a further 48 per cent are prefrail (at high risk of progressing to frailty).

Frailty is common clinical condition in which someone is more vulnerable to experiencing adverse outcomes in response to a stressor, such as a fall or minor medical procedure.

This condition is caused by a range of factors and often characterised by reduced strength, endurance, and physiological function. Because it develops gradually, frailty frequently goes unnoticed. More importantly, it can potentially be prevented or treated with simple interventions including exercise, diet and medication management.

And while frailty is linked with getting older, the two don’t have to go hand in hand. It’s about taking early interventions to help stay healthy and active for longer.

Prevention and management however, can only start when you realise that you – or someone you love – is becoming frail or at risk of frailty. Fortunately, easy and fast tools that assess your risk of frailty have been developed and validated by researchers.

Too often, ageing is associated with frailty. While ageing is inevitable, the rate in which physical decline occurs is not. It starts however, by recognising and monitoring your risk of frailty to ensure it’s managed at all stages of your life. When recognised early – or better still, before it starts – it’s easier to limit the impact of frailty, introduce interventions to prevent physical decline, and ensure that you can stay healthier and independent for longer living a full life in the community.

 

Screening for frailty

Doing the screening is just the first step. A screening tool is only as useful as what people do in response to them. It's all very well to know your cholesterol level, or what your risk of frailty is, but the most usefulness comes from what you do with that information. Complete a health check for you or your loved one.

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A Simple Screening Tool for Frailty

The Positive Ageing Tool (PAT)?

Several different tools are available to help older Australians proactively screen for frailty. As a leader in aged care service provision, Benetas invested in creating a simple yet highly effective tool that anyone can use. It’s called the Positive Ageing Tool, otherwise known as PAT.

Dr Catherine Joyce, Benetas’ General Manager of Quality Outcomes and Research, explains PAT is a short screening tool that helps people to monitor their frailty levels and provide tailored advice on steps forward.


Screening for positive action

She likens using PAT for frailty screening to having a blood test to check your cholesterol levels. “Doing the screening is just the first step,” she says. “A screening tool is only as useful as what people do in response to them. It's all very well to know your cholesterol level, or what your risk of frailty is, but the most usefulness comes from what you do with that information.

“If you don't make any changes to your diet or start on a cholesterol lowering medication, it's not going to make any difference. Similarly, PAT shows you where to make changes to lower your risk of adverse outcomes associated with frailty and to boost your chances of ageing well. The beauty of PAT is that it’s simple, but gives you really practical, helpful information.”

PAT can also be completed by the person at risk or someone who knows them well, such as a spouse or other family member.


Why would I use PAT?

Dr Joyce explains that PAT identifies your risk of experiencing poor health outcomes or adverse events due to frailty. Most importantly, “once you've identified people who are at high risk, you can do something to intervene. For example, you can support people to improve their strength or their balance to reduce their risk of falls.”

And PAT isn’t just for people who are unwell or with high levels of frailty. Dr Joyce explains there are frequently two extremes in how people think about frailty. “At one end, people may be acutely unwell and just think it's an inevitable part of getting older, so they don't look to do anything about it. At the other extreme, people can think ‘I'm not unwell’ and not realise how frail they actually are.

“Either way, these people don’t know what the risks are for them. The great thing about PAT is that it gives you an objective measure that says you’re at risk of poor health outcomes.”

In fact, PAT’s greatest potential lies in its capacity for early frailty detection and in turn intervention. As Dr Joyce says, “forewarned is forearmed”.

Furthermore, PAT allows you to monitor physical changes over time. “They are often quite subtle,” Dr Joyce points out. “If it's your parents or your partner and you are living with them or seeing them on a regular basis, you might not notice those gradual changes. Doing something like this as a check in provides an objective measure. For example, you might realise your mum could manage a flight of stairs six months ago but now she can't. That’s a trigger things have changed, and you need to do something about it.”


Power in simplicity

And while PAT is easy for almost anyone to complete, it isn’t as simple as it appears on the surface. It’s a bit like switching on a light – we take this simple action for granted, but significant research, experimentation and testing lies behind electricity. Similarly, PAT is a genuine clinical tool with strong research backing, Dr Joyce explains.

“The content was developed by an international group of gerontologists, or medical experts in ageing,” she says. “It’s based on really solid evidence about the key indicators of physical frailty. Once that content was identified, it was tested through research to make sure it was reliable and valid.”

This means the questions accurately identify frailty, and the results are a reliable predictor of risk for future adverse health outcomes. As Dr Joyce notes, “even though it might look like a Facebook poll, it has that really strong depth of evidence behind it.”


How does PAT work and how long does it take?

PAT involves answering five simple questions and only takes a few minutes to complete. However, it’s what those questions tell you that matters.

Take 51-year-old Christina as an example. She completed PAT for Theo, her 83-year-old father. Theo has high blood pressure, rheumatoid arthritis and diverticulitis, but feels he is in good health. He sees his GP for regular blood pressure checks, and a rheumatologist and gastroenterologist yearly for his other conditions. He enjoys growing vegetables in his garden and spending time with his children and grandchildren.

Christina found PAT and decided to test it. There were five easy questions that took less than two minutes. What surprised her was discovering Theo was not as robust as she thought. She knew he often felt tired but thought this was a normal part of getting older. His arthritis made it hard to climb a flight of stairs. Doing the test made her think more about Theo, and she realised he had lost weight over the past few months.

Christina left her name and email so she could receive the results, which showed Theo was at increased risk of poor health outcomes.

She was delighted to receive a 12-page health check report, which included personalised recommendations for Theo and a letter he could print and take to his GP for a focussed discussion on his frailty level.


What will PAT tell me?

As Dr Joyce explains, PAT not only screens for your risk of poor health outcomes. It provides:

  • Simple, evidence-based, and easy to implement steps you can take to address findings from the five questions;
  • Links to more detailed information; and
  • The option to get a comprehensive report (like the one Christina received).

Completing PAT provides you with a personalised set of things to consider based on your responses to the tool. “Some of those are things you need to do in consultation with your GP, like reviewing your medications,” Dr Joyce says. For older people, being on numerous medications (known as ‘polypharmacy’) can cause significant problems, such as increased risk of falls, nutritional deficiencies and impaired cognition.

In Theo’s case, a GP review revealed his specialists had unknowingly placed him on similar medications, and he was able to cut one of them out.

The other recommendations are around lifestyle factors, including advice about diet, sleep and physical activity. “There's a whole suite of resources available,” Dr Joyce says. As older people often experience poor appetite or loss of interest in food, these include nutritious recipes to support healthy weight. Being either over-or underweight can cause problems, and adequate nutrition is vital for healthy ageing, Dr Joyce explains.

After doing PAT, Christina talked to Theo and realised he had increasingly been surviving on coffee and toast – easy to prepare, but significantly lacking in nutrients! She learned Theo needed more protein and high-energy foods in his diet to combat weight loss and boost his energy levels. Christina was able to support him through simple things such as ensuring he had foods like chicken, eggs and full-fat dairy products in the fridge. Theo’s GP also referred him to a community dietitian for a personalised assessment.


Making healthy connections for positive ageing

A positive partnership with your doctor is a key aspect of PAT, Dr Joyce points out. “We want people to be working with their GP,” she says. “Definitely don’t change any medications before consulting with them and seek advice if you’re looking at increasing physical activity.”

You might also benefit from connecting with other healthcare workers, such as community nurses and allied health professionals. After Theo reviewed his results with Christina, he reconnected with a community physio he’d seen for his arthritis. He confessed to abandoning the exercise program she’d prescribed some time ago, but was happy to start a revised program to build leg strength and balance.


Challenging assumptions about ageing

Dr Joyce says one of PAT’s benefits is that it challenges assumptions that nothing can be done when people are starting to decline physically. “There's probably a bit of ageism in assuming it's just old age and that's how it goes,” she says. “PAT has an important role in providing a more positive view about the potential for people to maintain their function, or even improve it, well into advanced older age.”

 

Positive Ageing Tool

Start your Frailty Test

Start your Frailty Test
 

After the Frailty check (5 minute read)

What do I do with the results?

Have you or a loved one discovered you are frail or at risk of frailty? The upside is you can start taking steps to reduce your risk of becoming frail, limit the impact of frailty, or even reverse it in some cases.

Once you’ve been assessed, the next step is accessing appropriate therapies and services. This may include referral to a geriatrician or specialist physician as well as therapists, support workers and community services. Read More.

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